dimanche 27 septembre 2009

Breast sCare USA



Two books written by Diane Winaver, my gynecologist in France


I just had to get this off my chest.
I had my first mammogram at the age of 38, in France. After that, I had one every two years until I moved back to the United States. I have two small cysts, which are not dangerous but which need to be observed over time. Here's how it went in France: I would go and see the same specialist, who I was referred to by my terrific gynecologist. I found her through the wife of an American expat I worked with. Her name was on the US Embassy list. She's at the top of her field in France. I used to see her on television from time to time. She wrote lots of books, including one on how to talk to your teenage daughters about sex and reproduction. More recently, she has written a book on menopause.

The relative discomfort of a mammogram -- it feels like your breasts are being slammed repeatedly into a car door after being compressed beyond blood flow -- is no different in France than in the USA. In France, however, there are many more clichés taken in the course of a routine mammographie, as I recently discovered. And after that car door slams on your breast for the last time, the radiologist comes in and does a manual exam, asking a series of questions as he taps your boobs: How are your breasts? Any changes since the last time? Still doing those monthly self-exams? When was your last period? Etc. Then you sit in a waiting room that features a big aquarium while he looks at your clichés. Finally, he calls you in to tell you what he has seen and when to come back. In my case, it was always the same: come back in two years; everything is fine.

When I moved back to the US in 2006, I found it hard to adjust to the US healthcare system. It was hard to find an inroad. Luckily, my French healthcare coverage was extended for four years after I stopped paying into the system and left the country. That was nice of them. So I continued to see some of my favorite practitioners; it's just that doing so now entailed a trip to Paris. In addition to my gynecologist, I had a fabulous GP, a fabulous opthomologist, a fabulous dentist and a fabulous dermatologist. When I say fabulous, I mean people at the top of their fields in France. These are the people who get interviewed on television or for magazines. I felt truly cared for by these people and saw them once or twice a year for preventive care. It costs little and saves a lot. They always took great care, spent a lot of time, sat down and talked about ways of preventing disease. Most of them lived in my neighborhood. I would walk to their offices. I would see them on the street. My dentist had his office across the hall from my friend Monique's apartment.

I saw my first GP in Seattle in 2007. I like him alot. He's a family practitioner, so he does the routine pap smear and pelvic exam too. He suggested I have a couple of things done: the colonoscopy (done as a matter of routine in the US at age 50), the mammogram... stuff like that. Stupidly, I didn't get the mammogram done. I was too busy; my husband's company changed plans; it was all sort of confusing. The most confusing thing to me was this idea that you can only see certain doctors, depending on your plan. In France, we're all on the same plan and on the same page. If someone refers you to a doctor, you just go, knowing that you will be covered. Guess what? It costs money to offer this kind of trouble-free care. But it's worth it.

I finally decided to get the mammogram done a couple of weeks ago, not realizing that I was screwing up my GP's bookkeeping by waiting two years. Oh, well, a minor problem. When I went in for the mammogram, I immediately found it strange that only two clichés were done of each breast. I also found it strange when the technician told me I would be getting my results in the mail in about ten days. That seemed odd as well. No doctor in sight.

I got a call three days later from the office manager. Don't be alarmed, she said, but you need to come in for more clichés (or images, or whatever they call them here) and for an ultrasound. She then said something about dense tissue, cysts and so on. But I didn't really listen because I was totally freaking out. I had given the technician all my records from France, lovingly preserved in a heavy-duty plastic bag, each set of clichés bound in a thick envelope with the doctor's observations and signatures. An ultrasound?! WTF?!

I then decided that whatever was there, or not there, was there (or not there). Worrying and obsessing would not change anything; they would just fill my head with free-floating anxiety, based on my own ignorance of these matters. So I spent the days before the next set of exams thinking about other things. But I also kicked myself several times for not maintaining the every two years rhythm for those mammograms. I thought about my secretary, Marie Pierre, who was my faithful assistant for many years when I worked for a big corporation (The World Company, as we jokingly called it). She was given HRT when she went through menopause and developed breast cancer. I'll never forget our meeting, when she told me she would be out for awhile getting her breast lopped off. She was so afraid, and wanted to be so brave, and worried about how I would get along without her, and worried that I would do fine with a new assistant and she would lose her job. I cried with her; I reassured her. The fact is, I was toast without her. She was the most organized and loyal woman in the world. But her organization was a secret she must have decided never to share. Long story short, Marie Pierre survived her ordeal, came back to work for awhile, became a grandmother and decided to opt for early retirement when I went freelance. She said she was too old to get used to a new boss.

I also thought about one of my sisters-in-law, who is a breast cancer survivor. And I thought about my neighbor, who recently called me about a suspect mammogram, wanting names of people to see. She had had a lumpectomy four years ago, so she was freaked out. She was also freaked out because that was in another state and she didn't know who to see here. She wanted names. She said she wished she had just had her breasts cut off four years ago. Fortunately, things turned out fine for her. She returned for a second, more detailed mammogram and all is well.

My turn came on Friday. My husband insisted on coming with me. I said it wasn't necessary, but I'm glad he insisted. When we got there, I looked at the admission paper. It said "Complaint: abnormal mammogram". WTF?! Then I remembered my mantra: it is what it is. Relax. The second session consisted of taking all the extra clichés that are taken as a matter of routine in France. The technician told me that the doctor would look at them before doing the ultrasound, but that an ultrasound would probably be necessary as well. I went into the ladies only waiting room and flipped through a couple of Entertainment Weeklies. What a bunch of crap! A few minutes later, a different technician gave me a paper and said I was good to go. I looked at the paper. It said the results of the second mammogram were NORMAL, come back in a year. The technician said the doctor had looked at the dense tissue areas and found them to be perfectly consistent with the two cysts identified many years ago in France. No ultrasound. No doctor either. I never saw her.

Obviously, I felt as if an unacknowledged load had been lifted from my shoulders. I went from thinking I might lose my breasts to vowing that I would never, ever, miss another mammogram or two. Yeah, having your body contorted into uncomfortable positions while your breasts are individually and repeatedly smashed and then slammed into what feels like a car door, while someone tells you not to move and then, just when you could really use a deep intake of air, tells you not to breathe, is pretty uncomfortable. But it sure beats the alternatives!